Program offers help for those who take multiple medications

By Kara GavinUMHS Public Relations

Imagine taking nine or more medications every day. Consider the expense, the worry about forgetting a dose or doing the wrong thing, and the wondering about whether so many medicines might interact with each other, or with nonprescription drugs and dietary supplements.

A surprising number of people find themselves juggling multiple prescriptions for medicines that help them live with several health problems at once or reduce the risk of future problems. Research shows that nationwide 4.3 percent of all Americansnearly 13 million peopletake eight or more medications, and 7.7 percent take six or more. The percentages are higher among older adults.

The University is launching an innovative program to help improve health and reduce costs for U-M employees, retirees and dependents who take multiple prescription medications, starting with those who take nine or more. If successful, the project could be expanded, and the data gathered could help other employers and insurers develop similar programs.

Called MHealthy: Focus on Medicines, the pilot project will begin next month when the first of more than 3,000 letters will be mailed to adult members of the U-M community who have nine or more current medications filled through the U-M prescription drug plan. The plan serves more than 80,000 employees, retirees, dependents and survivors. More letters will be mailed in coming months.

The letters will include a list of all of the person's prescribed medicines, along with other information, such as how much the individual and U-M have paid for the medicines in recent months. All recipients will be sent written information about how to save money, and some also will receive an offer to speak with a U-M pharmacist by phone about ways to cut costs. Either way, recipients will learn about options such as pill splitting and switching to generic medicines or those that are on the U-M drug plan's less expensive preferred drug list.

Later this spring, some letter recipients will receive an invitation to have an even more in-depth, in-person discussion with a U-M pharmacist, called a Comprehensive Medication Review (CMR). Using the person's prescription drug list, his or her nonprescription drug, herb and supplement list, and his or her U-M health records, the pharmacist will look for opportunities to improve the safety and effectiveness of treatments. For example, the pharmacist might identify possible drug interactions, more effective or safer alternatives, and opportunities to add other preventive drugs or reduce the number of medicines.

The new project involves researchers and clinical pharmacists from the School of Pharmacy. The clinical pharmacists also work in U-M Health System clinics, where they regularly provide medication recommendations to patients and prescribers.

"This project is unique because it targets all beneficiaries who take multiple medications of any kind, for a broad range of medical conditions," says Leslie Shimp, the College of Pharmacy professor who leads the project. "We hope that it will give us valuable information about the impact of this broad-based approach so that we and other employers can offer this service to those who need it."

"With this pilot program, we're harnessing the expertise of our own faculty to help individuals who face the greatest challenges in terms of cost and health," says President Mary Sue Coleman. "As an employer, we constantly seek new ways to encourage the safe, appropriate and responsible use of medications to treat and prevent disease, and to contain health costs for our institution and our employees and retirees. These kinds of pilot programs can have important public health implications for cost-effectiveness and quality of care in our community and beyond."

The project is part of Michigan Healthy Community that last year launched MHealthy: Focus on Diabetesa program that provides free or low-cost drugs and testing to more than 2,000 employees and their dependents who have diabetes. So far, participants have saved more then $100,000 in co-pays, and evaluation is now under way to see if this has encouraged optimal use of preventive drugs.

The new Focus on Medicines program will not include employees or dependents with diabetes, to avoid interfering with that evaluation, but it will include retirees with diabetes.

Under Focus on Medicines, CMRs will be offered to participants selected randomly from among the employees, retirees and dependents who have a U-M doctor or nurse clinician as their primary care provider, in the Department of Family Medicine, Division of General Medicine or Division of Geriatric Medicine. The pharmacists will alert those physicians to immediate risks or opportunities, and their reports will be available to participants' U-M care providers via the UMHS electronic medical record.

The program has been designed to rigorously assess and compare the effects of the different approaches: letters, cost-only conversations with pharmacists and CMRs.

"This approach will allow us to evaluate the program's effects during the pilot phase, and to guide possible future expansion of the program," says Duane Kirking, director of the Center for Medication Use, Policy and Economics at the College of Pharmacy, which will evaluate the program. "Our objective evaluation can then be used by U-M to improve the program, and by other employers and insurers interested in offering similar programs."

Focus on Medicines is being funded in part by the Human Resources and Affirmative Action office, which administers the prescription drug plan through a contract with SXC Health Solutions, Inc. Keith Bruhnsen, who manages the prescription drug plan, says U-M has saved millions in administrative costs by encouraging the use of generics, preferred drugs and pill splitting. Quality and safety of medication use and prescribing have also improved in the four years since the drug plan began.

Though the Focus on Medicines project will include adults with any medical condition, the evaluation will focus on costs and health issues of those with asthma, chronic pain from osteoarthritis, diabetes, high blood pressure, high cholesterol and osteoporosis. These conditions, and others such as chronic acid reflux, depression and hypothyroidism, are among the most common reasons people take multiple medications. Patients often have more than one medical condition and may receive prescriptions from multiple doctors who specialize in the treatment of a particular disease.

"With every medicine that's added, every disease that's diagnosed and every additional provider involved in a patient's care, the risk of duplication, interactions between medications or problems with dosing increase, and opportunities to save money may be overlooked," says Shimp. "Add to this situation the fact that many patients never tell their primary care providers about which nonprescription medicines, herbal supplements, vitamins and minerals they take, and the risk of a problem is even more likely." At the same time, U-M Medical School studies show that out-of-pocket cost can make a big impact on patients' decisions to fill prescriptions and take medicines on schedule, which can affect their health.